The Science of Peer Support: Why Other People Are the Most Powerful Recovery Tool We Have

If one would create an addiction recovery program basing solely on the findings from scientific literature, then this program would be highly oriented toward relationships. It is not that one would be motivated by romantic ideas, but the connection between social determinants and recovery outcome has been found time after time and is quite consistent. The thing is that not only are social connections important while supporting people in maintaining their sobriety, but for many people, these relationships become a key to it.

At first glance, this idea seems to be quite obvious. Nevertheless, knowing more about the way peer support operates and the way it differs from the treatment that does not involve peer support may help one to better understand the future development of the system of addiction recovery.

Definition of Peer Support for Addiction Recovery

Peer support in addiction recovery refers to support coming from people who have undergone the same process concerning substance abuse disorders. Thus, peer support is not identical to professional support in this case. While the former will be a psychiatrist, a doctor, or any other healthcare professional, the latter will not.

The importance of this distinction is hard to underestimate. On the one hand, one receives things he or she can learn from a professional who is skilled and competent enough and knows everything about addiction recovery. On the other hand, there are things that only those who have undergone this situation can learn. People in recovery state that their relationships with peers help them to fill the gap that was created by professional relationships. Thus, both forms of support are equally important.

There are several forms of peer support in addiction recovery. The most widespread type is fellowship in twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous. The evidence concerning the effectiveness of various elements of this approach is different; however, the evidence for the effectiveness of peer support in twelve-step approach is quite reasonable. There are non-twelve-step approaches too, such as SMART recovery that uses cognitive and evidence-based techniques. Certified peer recovery specialist is a name given to peer support in addiction recovery who are trained and certified to provide services.

The Mechanisms of Peer Support

There are many researchers who have attempted to explain why peer support is effective since this would make it easier to design programs in a better way. There are several key elements which keep coming up.

Social modelling. The experience of seeing someone who has gone through something like you and has succeeded in building an independent life in recovery changes your perspective. The idea of encouragement coming from a therapist is helpful. But being confronted with a real person who’s achieved something is a totally different thing.

Accountability without shaming. The accountability which good peer relationships build is unique in comparison with self-monitoring and professional monitoring. The sponsors calling after you haven’t contacted them for a while, the support groups where your lack of participation is noticed, the peers you talk to about your craving and whom you know would ask you about it after – these are forms of accountability which are not institutional but relational.

Transferring practical knowledge. People who have been through treatment and early recovery possess information which cannot be found anywhere in any medical manual. They know where to find help when you need it in a particular city, how to deal with the situation if you need to tell about your problem to your employer and how to talk to family members who don’t trust you anymore. They know which situations may trigger people and when.

Belonging. One of the main themes in accounts of people’s early recovery is isolation. When someone stops using substances, he loses social connections, places, objects associated with drug use. This is where support through recovery, especially through recovery communities, starts making sense. Community meetings, sober events, recovery community centers and peer relations give people something else to belong to than drug circles. There is a large body of literature which confirms that isolation leads to relapse in addiction cases.

It means that discharge planning from any addiction treatment center must include not only referrals. It also means that those places where there is no strong network of recovery communities are structurally disadvantaged in recovery outcomes. It means that recovery community centers, peer support services and sober social environment are health investments in the most obvious way.

Evidence Base of Peer Support

The number of researches of the topic of peer support in addiction recovery increased greatly during the last fifteen years, and there are many things to feel encouraged with. It was found out that people who are helped by peers use drugs less often, stay in the hospital for shorter period of time, get more help during the treatment process and have better chances to stay sober for 12 months and longer.

Literature review ordered by the Substance Abuse and Mental Health Services Administration (SAMHSA) demonstrated that peer recovery support services lower the level of substance use and raise the level of mental health functioning and engagement in treatment in comparison with the traditional clinical treatment only. At present, SAMHSA actively promotes peer recovery support services as evidence-based practice and financially supports the development of these services as a part of its recovery-oriented systems of care initiatives.

According to the researches, peer support works better among such populations that are hard to involve in the process of traditional clinical treatment: people with negative experience of interaction with the healthcare system, people with criminal justice background, residents of rural areas with lack of access to clinical treatment facilities, and skeptical young adults.

Peer Support vs. Professional Treatment: Two Sides of the Same Coin

It should be emphasized that peer support works better when it is a part of professional treatment and not as its alternative. Substance abuse and addiction is a complicated medical condition. People with substance abuse and addiction problems usually suffer from other psychological conditions which should be treated medically. There is much evidence of the efficacy of medication-assisted treatment, buprenorphine, naltrexone and methadone treatment. Combining effective clinical treatment and strong peer support seems to be the most effective method at the moment.

The mistake committed by several approaches is in perception of these models as alternative to each other. While community approach is promoted as an alternative to clinical treatment, and vice versa. Those who recover better manage to use the best of both worlds.

Certified Peer Specialists as an Integral Part of the Treatment Process

One of the recent trends in the treatment of addiction is the appearance of certified peer specialists. They are trained in such skills as recovery coaching, motivational interviewing, and ethics and work as a part of professional clinical treatment team, working with clinicians and medical specialists, visiting recently discharged patients, staffing crisis lines and providing help to people who face critical periods in their recovery process.

It is not an additional option but a necessity. There are treatment settings in which peer specialists can reach the people who will not communicate with clinicians, create relations needed for involving them into the treatment process, and provide continuity of services in post-discharge, post-relapse and inter-clinical periods.

The Simple Truth Behind the Research

When all mechanisms and statistics are peeled off, the basic principle of peer support in addiction recovery becomes clear: people with experience of addiction recovery help other people to recover from it. Not being alone in this. Having somebody to talk to and someplace to go. Being treated like a person in recovery rather than like a problem to be solved. Peer support in addiction recovery was proved by the research. The community is the treatment. And it is not the only one, but perhaps the most irreplaceable one.